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Opinion statement

  • The management of acute HBV infection is supportive.

  • Specific treatment is not indicated for HBV carriers because they often have no evidence of liver injury, and, further, do not respond to currently available therapies.

  • Interferon monotherapy is best indicated for patients with chronic replicating HBV infection and evidence of chronic hepatitis. There is an increased likelihood of clearing HBsAg with interferon monotherapy as compared to lamivudine.

  • Lamivudine is an oral nucleoside analog that is better tolerated than interferon. The clinical situations for its use are far more than interferon monotherapy. Lamivudine should be used in patients with decompensated cirrhosis and also in transplantation, both before and after transplantation.

  • The post-transplant use of hepatitis B immune globulin (HBIG) and lamivudine combination therapy may be better for recipients who are identified in a replicative phase prior to transplantation.

  • Hepatitis B coinfection with one or more viruses, HCV, HDV, or HIV, may occur. Both interferon and lamivudine have been useful in these patients. However, the data are sparse and heterogeneous. Therapy with one or both drugs will have to be tailored to the clinical situation.

  • Combination therapy with immunomodulatory and/or antiviral drugs are what we will be looking toward in the future.

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References and Recommended Reading

  1. Lee WM: Hepatitis B Virus Infection. N Engl J Med 1997, 337:1733–1745. A thorough review article that touches on all aspects of HBV.

    Article  PubMed  CAS  Google Scholar 

  2. Margolis HS, Alter MJ, Hadler SC: Hepatitis B: Evolving epidemiology and implications for control. Semin Liver Dis 1991, 11:84–92.

    PubMed  CAS  Google Scholar 

  3. Lok AS, Lai CL, Wu PC, et al.: Hepatitis B virus infection in Chinese families in Hong Kong. Am J Epidemiol 1987, 126:492–499.

    PubMed  CAS  Google Scholar 

  4. Koff R: Vaccines and Hepatitis B. Clin Liver Dis 1999, 3:417–428.

    Article  Google Scholar 

  5. Pessoa M, Wright T: Update on clinical trials in treatment of hepatitis B. J Gastroenterol Hepatol 1999, 14(S):S6-S11.

    PubMed  CAS  Google Scholar 

  6. Terrault N: Hepatitis B virus and liver transplantation. Clin Liver Dis 1999, 3:389–415. An in-depth article on the natural history of disease, including recurrent hepatitis, and of treatment options for transplant recipients.

    Article  Google Scholar 

  7. WongDKH, Cheung AM, O’Rourke K, et al.: Effect of a-interferon treatment in patients with HBeAg+ chronic hepatitis B: A meta-analysis. Ann Intern Med 1993, 119:312–323. An analysis of 15 randomized studies that provides a cohesive picture of patient responses to IFN.

    PubMed  CAS  Google Scholar 

  8. Korenman J, Baker B, Waggoner J, et al.: Long-term remission of chronic hepatitis B after alpha-interferon therapy. Ann Intern Med 1991, 114:629–634.

    PubMed  CAS  Google Scholar 

  9. Mazella G, Saracco G, Festi D, et al.: Long-term results with interferon therapy in chronic type B hepatitis: a prospective randomized trial. Am J Gastroenterol 1999, 94:2246–2250.

    Article  Google Scholar 

  10. Perrillo RP, Schiff ER, Davis GL, et al.: A randomized, controlled trial of interferon ?-2b alone and after prednisone withdrawal in the treatment of chronic hepatitis B. N Engl J Med 1990, 323:295–301. A randomized, controlled trial which first demonstrated the ability of IFN to induce remission.

    Article  PubMed  CAS  Google Scholar 

  11. Khalili M, Perrillo R: Interferon therapy of Hepatitis B. Clin Liver Dis 1999, 3:363–387.

    Article  Google Scholar 

  12. Niederau C, Heintges T, Lange S, Goldmann G: Long-term follow-up of HbeAg-positive patients treated with interferon alpha for chronic hepatitis B. N Engl J Med 1996, 334:1422–1427.

    Article  PubMed  CAS  Google Scholar 

  13. Honkoop P, Hansen BE, Ashrof RZ, et al.: Long-term follow-up of chronic hepatitis B patients after interferon therapy [abstract]. J Hepatol 1998, 28(S1):112.

    Article  Google Scholar 

  14. Lau D, Everhart J, Kleiner D, et al.: Long-term follow-up of patients with chronic hepatitis B treated with interfeon alpha. Gastroenterol 1997, 113:1660–1667.

    Article  CAS  Google Scholar 

  15. Janssen H, Gerken G, Carreno V, et al.: Interferon alfa for chronic hepatitis B infection: increased efficacy of prolonged treatment. Hepatology 1999, 30:238–243.

    Article  PubMed  CAS  Google Scholar 

  16. Carreno V, Marcellin P, Hadziyannis Y, et al.: Retreatment of chronic hepatitis B e Antigen-positive patients with recombinant interferon alfa-2a. Hepatology 1999, 29:277–282.

    Article  Google Scholar 

  17. Tassopoulos N, Volpes R, Pastore G, et al.: Efficacy of lamivudine in patients with hepatitis B eAg-negative/ hepatitis B virus DNA-positive (precore mutant) chronic hepatitis B. Hepatology 1999, 29:889–896.

    Article  PubMed  CAS  Google Scholar 

  18. Lampertico P, Del Ninno E, Manzin A, et al.: A randomized, controlled trial of a 24-month course of interferon alpha 2b in patients with chronic hepatitis B who had hepatitis B virus DNA without hepatitis B e Ag in the serum. Hepatology 1997, 26:1621–1625.

    Article  PubMed  CAS  Google Scholar 

  19. Fattovich G, Farci P, Rugge M, et al.: A randomized controlled trial of lymphoblastoid interferon-alpha in patients with chronic hepatitis B lacking HBeAg. Hepatology 1992, 15:584–589.

    Article  PubMed  CAS  Google Scholar 

  20. Perillo RP, Tamburro C, Regenstein F, et al.: Low-dose titratable interferon alpha in decompensated liver disease caused by chronic infection with hepatitis B virus. Gastroenterology 1995, 109:908–916. Of interest to clinicians.

    Article  Google Scholar 

  21. Fattovich G, Giustina G, Realdi G, et al.: Long-term outcome of hepatitis B e Ag-positive patients with compensated cirrhosis treated with interferon a. Hepatology 1997, 26:1338–1342.

    Article  PubMed  CAS  Google Scholar 

  22. Farci P, Mandas A, Coiana A, et al.: Treatment of chronic hepatitis D with interferon-a-2a. N Engl J Med 1994, 330:88–94.

    Article  PubMed  CAS  Google Scholar 

  23. Hadziyannis S: Use of a-interferon in the treatment of chronic delta hepatitis. J Hepatol 1991, 13:S21-S26.

    Article  PubMed  Google Scholar 

  24. Gaudin J-L, Faure P, Godinot H, et al.: The french experience of treatment of chronic type D hepatitis with a 12-month course of interferon a-2b: results of a randomized trial. Liver 1995, 15:45–52.

    PubMed  CAS  Google Scholar 

  25. Rosina F, Pintus C, Meschievitz C, Rizzetto M: A randomized controlled trial of a 12-month course of recombinant human interferon-a in chronic delta (type D) hepatitis: a multicenter Italian study. Hepatology 1991, 13:1052–1056.

    Article  PubMed  CAS  Google Scholar 

  26. Madejon A, Cotonat T, Bartolome J, et al.: Treatment of chronic hepatitis D virus infection with low and high doses of interferon-a-2a: utility of polymerase chain reaction in monitoring antiviral response. Hepatology 1994, 19:1331–1336.

    PubMed  CAS  Google Scholar 

  27. Lau DT, Doo E, Park Y, et al.: Lamivudine for chronic delta hepatitis. Hepatology 1999, 30:546–549.

    Article  PubMed  CAS  Google Scholar 

  28. Liaw Y-F, Chien R-N, Lin S-M, et al.: Response of patients with dual hepatitis B virus and C virus infection to interferon therapy. J Interferon Cytokine Res 1997, 17:449–452.

    PubMed  CAS  Google Scholar 

  29. Weltman MD, Brotodihardjo A, Crewe EB, et al.: Coinfection with hepatitis B and C or B, C, and delta viruses results in a severe chronic liver disease and responds poorly to interferon-alpha treatment. J Viral Hepat 1995, 2:39.

    PubMed  CAS  Google Scholar 

  30. Zignego AL, Fontana R, Puliti S, et al.: Relevance of inapparent coinfection by hepatitis B virus in alpha interferon-treated patients with hepatitis C virus chronic hepatitis. J Med Virol 1997, 51:313–318.

    Article  PubMed  CAS  Google Scholar 

  31. Zacks S, Fried M: Hepatolog Cost comparison of interferon and lamivudine for the treatment of chronic hepatitis B [abstract]. Hepatology 1999, 30:483A.

    Google Scholar 

  32. Lai CL, Chien RN, Leung NWY, et al.: A one-year trial of lamivudine for chronic hepatitis B. N Engl J Med 1998, 339:61–68.

    Article  PubMed  CAS  Google Scholar 

  33. Honkoop P, de Man RA, Zonderuan PE, Schalm SW: Histological improvement in patients with chronic hepatitis B virus infection treated with lamivudine. Liver 1997, 17:103–106.

    PubMed  CAS  Google Scholar 

  34. Suzuki Y, Kumada H, Ikeda K, et al.: Histological changes in liver biopsies after one year of lamivudine treatment in patients with chronic hepatitis B infection. J Hepatol 1999, 30:743–748.

    Article  PubMed  CAS  Google Scholar 

  35. Dienstag JL, Schiff ER, Wright TL, et al.: Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med 1999, 341:1256–1263.

    Article  PubMed  CAS  Google Scholar 

  36. Liaw YF, Lai CL, Leung NWY, et al.: Two-year lamivudine therapy in chronic hepatitis B infection: results of a placebo controlled multi-centre study in Asia [abstract]. Gastroenterology 1998, 114.

  37. Rosenberg P, Dienstag J: Therapy with nucleoside analogs for hepatitis B virus infection. Clin Liver Dis 1999, 3:349–361.

    Article  Google Scholar 

  38. Nery J, Weppler D, Rodriguez M, et al.: Efficacy of lamivudine in controlling hepatitis virus recurrence after liver transplantation. Transplantation 1998, 65:1615–1621.

    Article  PubMed  CAS  Google Scholar 

  39. Bain V, Kneteman N, Ma M, et al.: Efficacy of lamivudine in chronic hepatitis B patients with active viral replication and decompensated cirrhosis undergoing liver transplantation. Transplantation 1996, 62:1456–1462.

    Article  PubMed  CAS  Google Scholar 

  40. Ben-Ari Z, Shmueli D, Mor E, et al.: Beneficial effect of lamivudine pre- and post-liver transplantation for hepatitis B infection. Transpl Proc 1997, 29:2687–2688.

    Article  CAS  Google Scholar 

  41. Gugenheim J, Baldini E, Ouzan D, et al.: Good results of lamivudine in hepatitis B surface antigen-positive patients with active viral replication before liver transplantation. Transpl Proc 1999, 31:554–555.

    Article  CAS  Google Scholar 

  42. Dodson S, Issa S, Bonham A: Liver transplantation for chronic viral hepatitis. Surg Clin North Am 1999, 79:131–143.

    Article  PubMed  CAS  Google Scholar 

  43. Grellier L, Mutimer D, Ahmed M, et al.: Lamivudine prophylaxis against reinfection in liver transplantation for hepatitis B cirrhosis. Lancet 1996, 348:1212–1215.

    Article  PubMed  CAS  Google Scholar 

  44. Nery J, Weppler D, Lavandera C, et al.: Developing strategies for prevention and treatment of recurrent HBV in liver transplantation. Transpl Proc 1998, 31:485–486.

    Article  Google Scholar 

  45. PerrilloR, Rakela J, Dienstag J, et al.: Multicenter study of lamivudine therapy for hepatitis B after liver transplantation. Hepatology 1999, 29:1581–1586. This study broadened the application of lamivudine by showing it was effective for post-transplant prophylaxis.

    Article  PubMed  CAS  Google Scholar 

  46. Lai CL, Liaw YF, Leung N, et al.: Lamivudine therapy for chronic hepatitis B infection: a 12 month placebo controlled, double-blind, multicenter study. J Hepatol 1997, 349:20–22.

    Google Scholar 

  47. Bartholomew M, Jansen R, Jeffers L, et al.: Hepatitis B virus resistance to lamivudine given for recurrent infection after orthotopic liver transplantation. Lancet 1997, 349:20–22. Of interest to clinicians.

    Article  PubMed  CAS  Google Scholar 

  48. Tur-Kaspa R, Burk R, Shaul Y, et al.: Hepatitis B virus DNA contains a glucocorticoid-responsive element. Proc Natl Acad Sci USA 1986, 82:1627.

    Article  Google Scholar 

  49. Rostaing L, Henry S, Cisterne J, et al.: Efficacy and safety of lamivudine on replication of recurrent hepatitis B after cadaveric renal transplantation. Transplantation 1997, 64:1624.

    Article  PubMed  CAS  Google Scholar 

  50. Goffin E, Horsmans Y, Cornu C, et al.: Lamivudine inhibits hepatitis B virus replication in kidney 1627. graft recipients. Transplantation 1998, 66:407–409.

    Article  PubMed  CAS  Google Scholar 

  51. Dulai G, Higa L, Kobashigawa J, Martin P: Successful use of lamivudine for severe cute hepatitis B virus infection in a cardiac transplant recipient. Transplantation 1999, 67:1288–1291.

    Article  PubMed  CAS  Google Scholar 

  52. Ter Borg F, Smorenburg S, De Man R, et al.: Recovery from life threatening, corticosteroid unresponsive, chemotherapy-related reactivation of hepatitis B associated with lamivudine therapy. Dig Dis and Sci 1998, 43:2267–2270.

    Article  Google Scholar 

  53. Ahmed A, Keefe E: Lamivudine therapy for chemotherapy-induced reactivation of hepatitis B virus infection. Am J Gastroenterol 1999, 94:249–251.

    Article  PubMed  CAS  Google Scholar 

  54. Benhamou Y, Katlama C, Lunel F, et al.: Effects of lamivudine on replication of hepatitis B virus in HIV-infected men. Ann Int Med 1996, 125:705–712.

    PubMed  CAS  Google Scholar 

  55. Benhamou Y, Dohin E, Lunel F, et al.: Efficacy of lamivudine on replication of hepatitis B virus in HIV-infected patients. Lancet 1995, 345:306–307.

    Article  Google Scholar 

  56. Wong D, Yim C, Naylor D, et al.: Interferon alfa treatment of chronic hepatitis B: randomized trial in a predominantly homosexual male population. Gastroenterology 1995, 108:165–171.

    Article  PubMed  CAS  Google Scholar 

  57. Chen P, Yim C, O’Rourke F, et al.: Long-term follow-up of a randomized trial of interferon therapy for chronic hepatitis B in a predominantly homosexual male population. J Hepatol 1999, 30:557–563.

    Article  PubMed  CAS  Google Scholar 

  58. Andreone P, Caraceni P, Grazi G, et al.: Lamivudine treatment for acute hepatitis B after liver transplantation. J Hepatol 1998, 29:985–989.

    Article  PubMed  CAS  Google Scholar 

  59. Schnittman S, Pierce P: Potential role of lamivudine (3TC) in the clearance of chronic hepatitis infection in a patient co-infected with HIV type I. Clin Infect Dis 1996, 23:638–639.

    PubMed  CAS  Google Scholar 

  60. Carton J, Maradona J, Asensi V, et al.: Lamivudine for chronic hepatitis B and HIV co-infection. AIDS 1999, 13:1002–1003.

    Article  PubMed  CAS  Google Scholar 

  61. Wolters L, Niesters H, de ManR, et al.: Antiviral treatment for human immunodeficiency virus patients co-infected with hepatitis B virus: combined effect for both infections, an obtainable goal? Antiviral Res 1999, 42:71–76.

    Article  PubMed  CAS  Google Scholar 

  62. Altfeld M, Rockstroh J, Addo M, et al.: Reactivation of hepatitis B in a long-term anti-Hbs-positive patient with AIDS following lamivudine withdrawal. J Hepatol 1998, 29:306–309.

    Article  PubMed  CAS  Google Scholar 

  63. Terrault N, Zhou S, McGory R, et al.: Incidence and clinical consequences of surface and polymerase gene mutations in liver transplant recipients on hepatitis B immunoglobulin. Hepatology 1998, 28:555.

    Article  PubMed  CAS  Google Scholar 

  64. Markowitz J, Martin P, Conrad A, et al.: Prophylaxis against hepatitis B recurrence following liver transplantation using combination lamivudine and hepatitis B immune globulin. Hepatology 1998, 28:585–589.

    Article  PubMed  CAS  Google Scholar 

  65. Todo S, DeMetris AJ, Van Thiel D, et al.: Orthotopic liver transplantation for patients with Hepatitis B virusrelated liver disease. Hepatology 1991, 13:619–626.

    PubMed  CAS  Google Scholar 

  66. Samuel D, Rainer M, Graeme A, et al.: Liver transplantation in European patients with the hepatitis B surface antigen. N Engl J Med 1993, 329:1842–1847.

    Article  PubMed  CAS  Google Scholar 

  67. Innaimo S, Seifer M, Bisacchi G, et al.: Identification of BMS-200475 as a potent and selective inhibitor of hepatitis B virus. Antimicrob Agents Chemother 1997, 41:1444–1448.

    PubMed  CAS  Google Scholar 

  68. Ono-Nita SK, Kato N, Shiratori Y, et al.: Susceptibility of lamivudine-resistant hepatitis B virus to other reverse transcriptase inhibitors. J Clin Invest 1999, 103:1635–1640.

    Article  PubMed  CAS  Google Scholar 

  69. Alexopoulou A, Zafiropoulou E, Papakonstantinou A, Hadziyannis S: Randomised trial in HBeAg negative chronic hepatitis B of oral nucleoside analogues in combination with interferon [abstract]. J Hepatol 1998, 28(S1):114.

    Article  Google Scholar 

  70. Oon CJ, Chen WN, Lim N, et al.: Hepatitis B virus variants with lamivudine-related mutations in the DNA polymerase and the ‘a’ epitope of the surface antigen are sensitive to ganciclovir. Antiviral Res 1999, 41:113–118.

    Article  PubMed  CAS  Google Scholar 

  71. Marques A, Lau DT, McKenzie R: Combination therapy with famciclovir and interferon-(for the treatment of chronic hepatitis B. J Infect Dis 1998, 178:1483–1487.

    Article  PubMed  CAS  Google Scholar 

  72. Singh N, Gayowski T, Wannstedt C, et al.: Pretransplant famciclovir as prophylaxis for hepatitis B virus recurrence after liver transplantation. Transplantation 1997, 63:1415–1419.

    Article  PubMed  CAS  Google Scholar 

  73. Carreno V, Zeuzem S, Hopf U, et al.: A phase I/II study of IL-12 in patients with chronic hepatitis B [abstract]. Hepatology 1999, 30:420A.

    Article  Google Scholar 

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Weakley, T., Reddy, K.R. Hepatitis B. Curr Treat Options Gastro 2, 463–472 (1999). https://doi.org/10.1007/s11938-999-0050-1

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  • DOI: https://doi.org/10.1007/s11938-999-0050-1

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